Osteoporosis Slide show

The Osteoporosis Landscape In India, an estimated 43 million women suffer from osteoporosis

India: Some Hard Facts Over 61 Million Indians have osteoporosis. 80% are women. On a global basis, Indians have the highest prevalence of osteopenia. Compared to Caucasians, osteoporotic fractures in the Indian population occur 10-12 years earlier in age. Osteoporotic fractures are more common in Indian men than in the West.

India: Some more hard facts Over 45 Lakhs Indian women above 60 have a fractured spine. Over 2.5 Lakhs Indians suffer osteoporotic hip fractures every year. Most of these fractures are never investigated for osteoporosis - and therefore never treated for the cause. Gupta et al, Indian Journal of Medical Research 1967:55:1341-8

Incidence of Hip fractures Asia will emerge as the largest sufferer of osteoporosis related fractures

Osteoporosis vs other diseases Total incidence of osteoporosis related fractures far exceeds other diseases

What makes us more prone? Indians have a poor calcium intake We don’t drink enough milk as children We have a higher incidence of varied degrees of lactose intolerance Rice is a poor source of calcium Vegetarian diets and cereals have low bio-availability of calcium (<30%) Vit D deficiency is common Protein intake is poor Excess salt intake – may increase urinary loss of calcium Healthy exercise is neglected Significantly lower BMD: mean spinal BMD by DEXA is 2SD below the American-European population between 20 to 59 yrs population* Lower BMI: osteoporosis is more common in thin women Late menarche’ in girls - low estrogen exposure Awareness is low *Nangia et al, ESICON 1977

Why is osteoporosis serious? It affects many more women than heart attacks, strokes and breast cancer together Osteoporosis kills by its complications-An osteoporotic fracture reduces the sufferer’s life expectancy by a decade. In addition, it seriously compromises quality of life Fractures are very expensive to treat-the economic burden of osteoporotic fractures is immense.

Common Fracture/BMD measurement Sites

World Health Organization (WHO) guidelines for osteoporosis Peak Bone Mass Normal Osteoporosis Osteopenia -1 T-Score -2.5 -2

Who to Treat? T-Score* Therapy Decision Below -2.5 High Risk Treat Above -1.0 Therapy Decision High Risk Treat Moderate Risk Treat if other risk factors Low Risk Check again in 1-2 years Treatment is critical for patients with fracture Other potential candidates for treatment are patients with low BMD and/or other risk factors The results from BMD testing provide a general guide for when to initiate therapy. As a rule of thumb, patients who present with a vertebral or hip fracture, those with a T-score lower than -2.0 and no risk factors, and patients with a T-score lower than -1.5 and other risk factors, as well as those in whom nonpharmacologic measures are ineffective, are candidates for drug treatment to reduce the risk for fracture.27 Many of these patients have already experienced fracture and may have “silent” fractures. While women with a T-score above -1.5 generally do not require drug therapy, they should be encouraged to follow the fundamental measures for bone health and be monitored every 1 to 2 years for changes in fracture risk.28 International Osteoporosis Foundation. 1998.

Osteoporosis: a team work Sp. Doctor Dietitian Govt. NGO Patient & Family Sp. Nurse Orthopaedic Surgeon Physio. Orthotist Fm. Doctor